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31.08.2016 | Original articles

Intracoronary pressure measurement differences between anterior and posterior coronary territories

verfasst von: Dr. T. Härle, S. Meyer, W. Bojara, F. Vahldiek, A. Elsässer

Erschienen in: Herz | Ausgabe 4/2017

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Abstract

Introduction

Intracoronary pressure measurements have improved assessment of angiographic intermediate coronary stenoses. Methodically, pressure equalization and actual measurements are frequently performed at different height levels, depending on the particular coronary territory analyzed. Considering a hypothetical influence of hydrostatic pressure and the supine position of the patient, differences in the results of intracoronary measurements between anterior and posterior vessels seem likely. The purpose of this study was to compare the results of intracoronary pressure measurements between anterior and posterior coronary territories.

Methods

Intracoronary pressure measurements of 214 coronary stenoses in 158 patients were analyzed. Fractional flow reserve (FFR) was measured in all stenosis and instantaneous wave-free ratio (iFR) in 197 stenoses in 144 patients.

Results

Both FFR (0.79 vs. 0.87, p < 0.001) and iFR values (0.86 vs. 0.94, p < 0.001) were significantly higher in posterior compared to anterior coronary vessels. Patients with only anterior or posterior lesions did not differ regarding clinical or lesion characteristics, in particular coronary stenosis severity (62.5 vs. 61.6 %, p = 0.27).

Conclusions

Results of intracoronary measurements were systematically higher in the posterior coronary vessels when compared with anterior vessels. This phenomenon was independent of coronary stenosis severity or any clinical characteristics in our study population.

Pijls NH, De Bruyne B, Peels K et al (1996) Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med 334:1703–1708. doi:10.1056/NEJM199606273342604 CrossRefPubMed

Tonino PA, Fearon WF, De Bruyne B et al (2010) Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol 55:2816–2821. doi:10.1016/j.jacc.2009.11.096 CrossRefPubMed

Fearon WF, Bornschein B, Tonino PA et al (2010) Economic evaluation of fractional flow reserve-guided percutaneous coronary intervention in patients with multivessel disease. Circulation 122:2545–2550. doi:10.1161/CIRCULATIONAHA.109.925396 CrossRefPubMed

Pijls NH, van Schaardenburgh P, Manoharan G et al (2007) Percutaneous coronary intervention of functionally nonsignificant stenosis: 5‑year follow-up of the DEFER Study. J Am Coll Cardiol 49:2105–2111. doi:10.1016/j.jacc.2007.01.087 CrossRefPubMed

Pijls NH, van Son JA, Kirkeeide RL et al (1993) Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty. Circulation 87:1354–1367CrossRefPubMed

Tonino PA, De Bruyne B, Pijls NH et al (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 360:213–224CrossRefPubMed

Kern MJ (2012) An adenosine-independent index of stenosis severity from coronary wave-intensity analysis: a new paradigm in coronary physiology for the cath lab? J Am Coll Cardiol 59:1403–1405. doi:10.1016/j.jacc.2011.11.006 CrossRefPubMed

Spaan JA, Piek JJ, Hoffman JI, Siebes M (2006) Physiological basis of clinically used coronary hemodynamic indices. Circulation 113:446–455. doi:10.1161/CIRCULATIONAHA.105.587196 CrossRefPubMed

Pijls NH, Van Gelder B, Van der Voort P et al (1995) Fractional flow reserve. A useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow. Circulation 92:3183–3193CrossRefPubMed

10.

Sen S, Escaned J, Malik IS et al (2012) Development and validation of a new adenosine-independent index of stenosis severity from coronary wave-intensity analysis: results of the ADVISE (ADenosine Vasodilator Independent Stenosis Evaluation) study. J Am Coll Cardiol 59:1392–1402. doi:10.1016/j.jacc.2011.11.003 CrossRefPubMed

11.

Härle T, Bojara W, Meyer S, Elsässer A (2015) Comparison of instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) – First real world experience. Int J Cardiol 199:1–7. doi:10.1016/j.ijcard.2015.07.003 CrossRefPubMed

12.

Petraco R, Escaned J, Sen S et al (2013) Classification performance of instantaneous wave-free ratio (iFR) and fractional flow reserve in a clinical population of intermediate coronary stenoses: results of the ADVISE registry. EuroIntervention 9:91–101. doi:10.4244/eijv9i1a14 CrossRefPubMed

13.

Pijls NH, Sels JW (2012) Functional measurement of coronary stenosis. J Am Coll Cardiol 59:1045–1057. doi:10.1016/j.jacc.2011.09.077 CrossRefPubMed

14.

White CW, Wright CB, Doty DB et al (1984) Does visual interpretation of the coronary arteriogram predict the physiologic importance of a coronary stenosis? N Engl J Med 310:819–824. doi:10.1056/NEJM198403293101304 CrossRefPubMed

15.

Escaned J, Echavarria-Pinto M, Garcia-Garcia HM et al (2015) Prospective assessment of the diagnostic accuracy of instantaneous wave-free ratio to assess coronary Stenosis relevance: results of ADVISE II International, Multicenter study (ADenosine vasodilator independent Stenosis evaluation II). JACC Cardiovasc Interv 8:824–833. doi:10.1016/j.jcin.2015.01.029 CrossRefPubMed

16.

Petraco R, van de Hoef Nijjer TPS et al (2014) Baseline instantaneous wave-free ratio as a pressure-only estimation of underlying coronary flow reserve: results of the JUSTIFY-CFR Study (Joined Coronary Pressure and Flow Analysis to Determine Diagnostic Characteristics of Basal and Hyperemic Indices of Functional Lesion Severity-Coronary Flow Reserve). Circ Cardiovasc Interv 7:492–502. doi:10.1161/CIRCINTERVENTIONS.113.000926 CrossRefPubMed

17.

Sen S, Asrress KN, Nijjer S et al (2013) Diagnostic classification of the instantaneous wave-free ratio is equivalent to fractional flow reserve and is not improved with adenosine administration. Results of CLARIFY (Classification Accuracy of Pressure-Only Ratios Against Indices Using Flow Study). J Am Coll Cardiol 61:1409–1420. doi:10.1016/j.jacc.2013.01.034 CrossRefPubMed

18.

Tobis J, Azarbal B, Slavin L (2007) Assessment of intermediate severity coronary lesions in the catheterization laboratory. J Am Coll Cardiol 49:839–848. doi:10.1016/j.jacc.2006.10.055 CrossRefPubMed

19.

Gould KL, Kelley KO, Bolson EL (1982) Experimental validation of quantitative coronary arteriography for determining pressure-flow characteristics of coronary stenosis. Circulation 66:930–937CrossRefPubMed

20.

Christou MA, Siontis GC, Katritsis DG, Ioannidis JP (2007) Meta-analysis of fractional flow reserve versus quantitative coronary angiography and noninvasive imaging for evaluation of myocardial ischemia. Am J Cardiol 99:450–456. doi:10.1016/j.amjcard.2006.09.092 CrossRefPubMed

21.

Nudi F, Schillaci O, Neri G et al (2016) Prognostic impact of location and extent of vessel-related ischemia at myocardial perfusion scintigraphy in patients with or at risk for coronary artery disease. J Nucl Cardiol 66:274–284. doi:10.1007/s12350-015-0077-8 CrossRef

22.

van de Hoef TP, Siebes M, Spaan JA, Piek JJ (2015) Fundamentals in clinical coronary physiology: why coronary flow is more important than coronary pressure. Eur Heart J 36:3312–3319. doi:10.1093/eurheartj/ehv235 CrossRefPubMed

23.

van de Hoef TP, Nolte F, Rolandi MC et al (2012) Coronary pressure-flow relations as basis for the understanding of coronary physiology. J Mol Cell Cardiol 52:786–793. doi:10.1016/j.yjmcc.2011.07.025 CrossRefPubMed

24.

De Bruyne B, Pijls NH, Paulus WJ et al (1993) Transstenotic coronary pressure gradient measurement in humans: in vitro and in vivo evaluation of a new pressure monitoring angioplasty guide wire. J Am Coll Cardiol 22:119–126. doi:10.1016/0735-1097(93)90825-L CrossRefPubMed

25.

Leone AM, De Caterina AR, Basile E et al (2013) Influence of the amount of myocardium subtended by a stenosis on fractional flow reserve. Circ Cardiovasc Interv 6:29–36. doi:10.1161/circinterventions.112.971101 CrossRefPubMed

26.

De Bruyne B, Baudhuin T, Melin JA et al (1994) Coronary flow reserve calculated from pressure measurements in humans. Validation with positron emission tomography. Circulation 89:1013–1022. doi:10.1161/01.CIR.89.3.1013 CrossRefPubMed

27.

Layland J, Wilson AM, Whitbourn RJ et al (2013) Impact of right atrial pressure on decision-making using fractional flow reserve (FFR) in elective percutaneous intervention. Int J Cardiol 167:951–953. doi:10.1016/j.ijcard.2012.03.087 CrossRefPubMed

28.

Gould KL (1978) Pressure-flow characteristics of coronary stenoses in unsedated dogs at rest and during coronary vasodilation. Circ Res 43:242–253. doi:10.1161/01.RES.43.2.242 CrossRefPubMed

29.

Meijboom WB, Van Mieghem CA, van Pelt N et al (2008) Comprehensive assessment of coronary artery stenoses: computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina. J Am Coll Cardiol 52:636–643. doi:10.1016/j.jacc.2008.05.024 CrossRefPubMed

Titel: Intracoronary pressure measurement differences between anterior and posterior coronary territories
verfasst von: Dr. T. Härle
S. Meyer
W. Bojara
F. Vahldiek
A. Elsässer
Publikationsdatum: 31.08.2016
Verlag: Springer Medizin
Erschienen in: Herz / Ausgabe 4/2017
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI: https://doi.org/10.1007/s00059-016-4471-z

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Intracoronary pressure measurement differences between anterior and posterior coronary territories

Abstract

Introduction

Methods

Results

Conclusions

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Abstract

Introduction

Methods

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Conclusions

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